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A preferred provider organization is a subscription-based medical care arrangement. [1] A membership allows a substantial discount below the regularly charged rates of the designated professionals partnered with the organization. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the ...
t. e. The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("managed care techniques"). It has become the predominant system of delivering and receiving ...
Sanus was a health maintenance organization and it merged with the General America Life Insurance preferred provider organization. [12] Sanus rapidly grew and by 1986 it had 200,000 clients and $100 million in revenue, operating in the St. Louis, Dallas, Fort Worth, Houston, and Washington, D.C. markets. It created a subsidiary called GenCare ...
v. t. e. In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. [1] It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health ...
Health Insurance Plan of Greater New York (HIP) was incorporated in 1944 as the first health insurance plan for public service workers. [9] The company was founded by David M. Heyman with the support of New York City mayor Fiorello LaGuardia, who wanted to offer medical services to New Yorkers of “moderate means.” [10] HIP got its first members in 1947.
Municipal health coverage. v. t. e. An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation.
Most preferred provider organization plans are open-network (those that are not are often described as exclusive provider organizations, or EPOs), as are point of service (POS) plans. The terms "open panel" and "closed panel" are sometimes used to describe which health care providers in a community have the opportunity to participate in a plan.
Fee-for-service. Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. [1] In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. However evidence of the effectiveness of FFS in improving health ...